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Improving Implementation of Government Health Insurance (GHI) in Public Tertiary Care Hospitals for Free In patient Care Experience A Preliminary Proposal Submitted to State Health Assurance Agency

ReportsMay 31, 2022

In India, all 28 States and eight Union Territories (UTs) implement Government Health Insurance (GHI) to ensure free hospitalisation in a network of private and public hospitals to insulate households from catastrophic out-of-pocket (OOP) health expenditures. Most large private hospitals with integrated care facilities are yet to join the GHI network. Most private hospitals in GHI are small (<25 beds) with limited infrastructure, concentrated in some states and a limited presence in others . Conversely, public hospitals up to the district levels meet only some secondary care needs and public tertiary care institutions serve the most of hospitalisation needs, especially all tertiary care needs. Except for user fees, in-patient care in these hospitals must not cause financial hardship. Nonetheless, various studies report considerable out-of-pocket (OOP) expenditures on in-patient care in these hospitals (2-10), distinct from the informal payments described elsewhere . In India, households incur OOP expenses on purchasing various supplies and services2 because those may not be available in public hospitals. Given state governments’ free drugs and diagnostics schemes and condition-specific free care in various national programmes, this is perplexing (12-15). GHI reimbursements are additional revenues for the public hospitals. Interestingly, all residents in twenty-one out of 28 States and all UTs are insured or eligible under GHI. Public hospital inpatients mostly come from low-income households (16,17) whose coverage is a priority for GHI. It implies a higher propensity of insured patients in these hospitals. The GHI benefit package covers almost all aspects of in-patient care with minimum exclusions . These hospitals, it seems, have the necessary means, potential, motivation, and obligations to provide free inpatient care to all, especially GHI patients, yet those may be reporting fewer GHI claims

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